Provider Demographics
NPI:1790330009
Name:COUSINS, DANYEL LINDA
Entity Type:Individual
Prefix:
First Name:DANYEL
Middle Name:LINDA
Last Name:COUSINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 RIVER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3772
Mailing Address - Country:US
Mailing Address - Phone:207-798-1688
Mailing Address - Fax:
Practice Address - Street 1:247 WASHINGTON ST STE 26
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1779
Practice Address - Country:US
Practice Address - Phone:508-944-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health